| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,256 |
1,194 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,668 |
1,571 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
430 |
338 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,143 |
1,037 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
369 |
177 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,170 |
1,114 |
$26K |
| D0330 |
Panoramic radiographic image |
384 |
376 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
496 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
134 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
476 |
266 |
$12K |
| D1206 |
Topical application of fluoride varnish |
474 |
466 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,383 |
$8K |
| D1120 |
Prophylaxis - child |
181 |
179 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
995 |
417 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$975.00 |
| D0270 |
|
117 |
112 |
$527.00 |
| D0350 |
|
48 |
43 |
$482.48 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
26 |
$390.00 |
| D4910 |
|
14 |
13 |
$301.17 |
| D1999 |
|
12 |
12 |
$0.00 |